title: Citrate Pharmacokinetics in Critically Ill Patients with Acute Kidney Injury.
abstract: Regional citrate anticoagulation (RCA) is gaining popularity in continous renal replacement therapy (CRRT) for critically ill patients. The risk of citrate toxicity is a primary concern during the prolonged process. The aim of this study was to assess the pharmacokinetics of citrate in critically ill patients with AKI, and used the kinetic parameters to predict the risk of citrate accumulation in this population group undergoing continuous veno-venous hemofiltration (CVVH) with RCA.
  
  
  
  Critically ill patients with AKI (n = 12) and healthy volunteers (n = 12) were investigated during infusing comparative dosage of citrate. Serial blood samples were taken before, during 120 min and up to 120 min after infusion. Citrate pharmacokinetics were calculated and compared between groups. Then the estimated kinetic parameters were applied to the citrate kinetic equation for validation in other ten patients' CVVH sessions with citrate anticoagulation.
  
  
  
  Total body clearance of citrate was similar in critically ill patients with AKI and healthy volunteers (648.04±347.00 L/min versus 686.64±353.60 L/min; P = 0.624). Basal and peak citrate concentrations were similar in both groups (p = 0.423 and 0.247, respectively). The predicted citrate curve showed excellent fit to the measurements.
  
  
  
  Citrate clearance is not impaired in critically ill patients with AKI in the absence of severe liver dysfunction. Citrate pharmacokinetic data can provide a basis for the clinical use of predicting the risk of citrate accumulation.
  
  
  
  ClinicalTrials.gov Identifier NCT00948558.
authors.affiliation: Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China.
authors.forename: Yin
authors.initials: Y
authors.lastname: Zheng
authors.forename: Zhongye
authors.initials: Z
authors.lastname: Xu
authors.forename: Qiuyu
authors.initials: Q
authors.lastname: Zhu
authors.forename: Junfeng
authors.initials: J
authors.lastname: Liu
authors.forename: Jing
authors.initials: J
authors.lastname: Qian
authors.forename: Huaizhou
authors.initials: H
authors.lastname: You
authors.forename: Yong
authors.initials: Y
authors.lastname: Gu
authors.forename: Chuanming
authors.initials: C
authors.lastname: Hao
authors.forename: Zheng
authors.initials: Z
authors.lastname: Jiao
authors.forename: Feng
authors.initials: F
authors.lastname: Ding
mesh_terms: D058186:Acute Kidney Injury / Q000378:metabolism*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000493:pharmacokinetics*; D019343:Citric Acid / Q000493:pharmacokinetics*; D016638:Critical Illness; D005260:Female; D006440:Hemofiltration / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D000925:Anticoagulants; D019343:Citric Acid